scholarly journals Durability of single tablet regimen for patients with HIV infection in Southern Taiwan: data from a real-world setting

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hui-Min Chang ◽  
Chen-Hsi Chou ◽  
Hung-Chin Tsai
Keyword(s):  
Treatment Failure ◽  
Virological Failure ◽  
Real World ◽  
Tenofovir Disoproxil Fumarate ◽  
Cox Proportional Hazards Model ◽  
Syphilis Infection ◽  
Single Tablet Regimen ◽  
Younger Age ◽  
Southern Taiwan ◽  
Active Syphilis

Abstract Background A single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unknown in the real-world settings. Our aim was to investigate the durability of different initial STR regimens in antiretroviral-naive patients starting STR in southern Taiwan. Method This was a retrospective study of antiretroviral-naive patients that initiated first-line antiretroviral regimens with STRs between May 2016 and December 2017. The primary endpoint was time to virological failure. Secondary endpoints were STR discontinuation due to toxicity/intolerance. Durability was defined as time from the initiation until discontinuation/modification. Kaplan- Meier curves were plotted assessing time to virological suppression, treatment failure and discontinuation for the three STRs and Cox proportional hazards model was used to analyze the factors associated with time to viral suppression, treatment failure or discontinuation. Results Two hundred and twenty-three patients were included: The median follow-up duration (IQR) was 73.9 (48–101.6) weeks, 25 patients (11%) experienced virological failure; the 48 weeks probability of treatment failure was 22.9% (16/70) for Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate (EFV/FTC/TDF), 24.1% (13/54) for Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (FTC/RPV/TDF) and 24.2% (24/99) for Abacavir/Dolutegravir/Lamivudine (ABC/DTG/3TC) (p=0.16). Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to EFV/FTC/TDF, treatment with FTC/RPV/TDF (aHR 8.39, CI 1.98–35.58, p = 0.004) and ABC/DTG/3TC (aHR 8.40, CI 2.39–29.54, p=0.001) were more likely to have treatment failure. The predictors for treatment failure included age ≦ 30 years old (aHR 3.73, CI 1.25–11.17, p = 0.018), switch between different STR (aHR 2.3, CI 1.18–4.50, p  = 0.001) and free of active syphilis infection (aHR 0.24, CI 0.08–0.73, p = 0.012). The risk factor for treatment discontinuation included younger age ≦ 30 years old (aHR 3.82, CI 1.21–12.37, p = 0.023), treatment with EFV/FTC/TDF (aHR 8.65, CI 2.64–28.39, p < 0.001) and free of active syphilis infection (aHR 0.16, CI 0.04–0.62, p = 0.006). Conclusion Younger age was associated with treatment failure and drug discontinuation. Active syphilis infection s/p treatment was associated with free from treatment failure and discontinuation. This probably driven by the more frequently sexual health education and counseling when patients had syphilis infection. Treatment with ABC/DTG/3TC was associated with higher risk of treatment failure. The STR durability was dependent on the drug toxicity/intolerance, age and syphilis infection.

scholarly journals Durability of Single Tablet Regimen for Patients with HIV infection in Southern Taiwan: data from a real world setting

2020 ◽  
Author(s):  
Hui-Min Chang ◽  
Chen-Hsi Chou ◽  
Hung-Chin Tsai
Keyword(s):  
Treatment Failure ◽  
Virological Failure ◽  
Real World ◽  
Tenofovir Disoproxil Fumarate ◽  
Syphilis Infection ◽  
Single Tablet Regimen ◽  
Younger Age ◽  
Southern Taiwan ◽  
Risk Of Treatment ◽  
Active Syphilis

Abstract Background: A single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unknown in the real world settings. Our aim was to investigate the durability of different initial STR regimens in patients starting STR in southern Taiwan Method: This was a retrospective study of antiretroviral-naive patients that initiated first-line antiretroviral regimens with STRs between May 2016 and December 2017. The primary endpoint was time to virological failure (defined as plasma HIV RNAs≧200 copies/mL after 24 weeks). Secondary endpoints were STR discontinuation due to toxicity/intolerance. Survival analysis was done using Kaplan–Meier and Cox regression.Results: Two hundred and twenty-three patients were included: Over a median (IQR) of 86 (60-112) weeks, 25 patients (11%) experienced virological failure; the 1 year probability of virological failure was 11% (8/70) for Efavirenz/Emtricitabine/ Tenofovir Disoproxil Fumarate, 7% (4/54) for Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate and 13% (13/99) for Abacavir/Dolutegravir/Lamivudine. Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to Efavirenz/Emtricitabine/ Tenofovir Disoproxil Fumarate, treatment with Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (AHR 8.39, CI 1.98-35.58, p=0.004) and Abacavir/Dolutegravir/Lamivudine (AHR 8.40, CI 2.39-29.54, p=0.001) were more likely to have treatment failure. However, when the risk of treatment failure was compared between two different STRs, treatment with Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate was not found to have higher risk of treatment failure when compared to Efavirenz/Emtricitabine/ Tenofovir Disoproxil Fumarate (log rank test p=0.116). The predictors for treatment failure included age≦30 years old (AHR 3.73, CI 1.25-11.17, p=0.018), switch between different STR (AHR 2.3, CI 1.18-4.50, p=0.001) and free of active syphilis infection (AHR 0.24, CI 0.08-0.73, p=0.012). The risk factor for treatment discontinuation included younger age≦30 years old (AHR 3.82, CI 1.21-12.37, p=0.023), treatment with Efavirenz/Emtricitabine/ Tenofovir Disoproxil Fumarate (AHR 8.65 , CI 2.64-28.39 , p<0.001) and free of active syphilis infection (AHR0.16, CI 0.04-0.62, p=0.006). Conclusion: Younger age was associated with treatment failure and drug discontinuation. Active syphilis infection s/p treatment was associated with free from treatment failure and discontinuation. This probably driven by the more frequently sexual health education and counseling when patients had syphilis infection. The STR durability was dependent on the drug toxicity/intolerance, age and syphilis infection

scholarly journals Durability of Single Tablet Regimen for Patients with HIV infection in Southern Taiwan: data from a real world setting

2020 ◽  
Author(s):  
Hung-Chin Tsai ◽  
Hui-Min Chang ◽  
Chen-Hsi Chou
Keyword(s):  
Treatment Failure ◽  
Virological Failure ◽  
Real World ◽  
Cox Regression ◽  
Syphilis Infection ◽  
Single Tablet Regimen ◽  
Younger Age ◽  
Southern Taiwan ◽  
Risk Of Treatment ◽  
Active Syphilis

Abstract Background: A single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unknown in the real world settings. Our aim was to investigate the durability of different initial STR regimens in patients starting STR in southern Taiwan Method: This was a retrospective study of antiretroviral-naive patients that initiated first-line antiretroviral regimens with STRs between May 2016 and December 2017. The primary endpoint was time to virological failure (defined as plasma HIV RNAs≧200 copies/mL after 24 weeks). Secondary endpoints were STR discontinuation due to toxicity/intolerance. Survival analysis was done using Kaplan–Meier and Cox regression. Results: Two hundred and twenty-three patients were included: Over a median (IQR) of 86 (60-112) weeks, 25 patients (11%) experienced virological failure; the 1 year probability of virological failure was 11% (8/70) for Atripla, 7% (4/54) for Complera and 13% (13/99) for Triumeq. Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to Atripla, treatment with Complera (AHR 8.39, CI 1.98-35.58, p=0.004) and Triumeq (AHR 8.40, CI 2.39-29.54, p=0.001) were more likely to have treatment failure. However, when the risk of treatment failure was compared between two different STRs, treatment with Complera was not found to have higher risk of treatment failure when compared to Atripla (log rank test p=0.116). The predictors for treatment failure included age≦30 years old (AHR 3.73, CI 1.25-11.17, p=0.018), switch between different STR (AHR 2.3, CI 1.18-4.50, p=0.001) and free of active syphilis infection (AHR 0.24, CI 0.08-0.73, p=0.012). The risk factor for treatment discontinuation included younger age≦30 years old (AHR 3.82, CI 1.21-12.37, p=0.023), treatment with Atripla (AHR 8.65 , CI 2.64-28.39 , p<0.001) and free of active syphilis infection (AHR0.16, CI 0.04-0.62, p=0.006). Conclusion: Younger age was associated with treatment failure and drug discontinuation. Active syphilis infection s/p treatment was associated with free from treatment failure and discontinuation. This probably driven by the more frequently sexual health education and counseling when patients had syphilis infection. The STR durability was dependent on the drug toxicity/intolerance, age and syphilis infection

Paediatric empyema: worsening disease severity and challenges identifying patients at increased risk of repeat intervention

2020 ◽  
Vol 105 (9) ◽  
pp. 886-890 ◽  
Author(s):  
Stuart Haggie ◽  
Hasantha Gunasekera ◽  
Chetan Pandit ◽  
Hiran Selvadurai ◽  
Paul Robinson ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Initial Treatment ◽  
Group A Streptococcus ◽  
Thoracoscopic Surgery ◽  
Tertiary Hospital ◽  
Fibrinolytic Therapy ◽  
Younger Age ◽  
Increased Risk ◽  
Group A ◽  
Single Intervention

ObjectiveEmpyema is the most common complication of pneumonia. Primary interventions include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS). We describe disease trends, clinical outcomes and factors associated with reintervention.Design/setting/patientsRetrospective cohort of paediatric empyema cases requiring drainage or surgical intervention, 2011–2018, admitted to a large Australian tertiary children’s hospital.ResultsDuring the study, the incidence of empyema increased from 1.7/1000 to 7.1/1000 admissions (p<0.001). We describe 192 cases (174 CDF and 18 VATS), median age 3.0 years (IQR 1–5), mean fever duration prior to intervention 6.2 days (SD ±3.3 days) and 50 (26%) cases admitted to PICU. PICU admission increased during the study from 18% to 34% (p<0.001). Bacteraemia occurred in 23/192 (12%) cases. A pathogen was detected in 131/192 (68%); Streptococcus pneumoniae 75/192 (39%), S. aureus 25/192 (13%) and group A streptococcus 13/192 (7%). Reintervention occurred in 49/174 (28%) and 1/18 (6%) following primary CDF and VATS. Comparing repeat intervention with single intervention cases, a continued fever postintervention increased the likelihood for a repeat intervention (OR 1.3 per day febrile; 95% CI 1.2 to 1.4, p<0.0001). Younger age, prolonged fever preintervention and previous antibiotic treatment were not associated with initial treatment failure (all p>0.05).ConclusionWe report increasing incidence and severity of empyema in a large tertiary hospital. One in four patients required a repeat intervention after CDF. Neither clinical variables at presentation nor early investigations were able to predict initial treatment failure.

scholarly journals Comparison of Efficacy in Patients with Metastatic Melanoma Treated with Ipilimumab and Nivolumab Who Did or Did Not Discontinue Treatment Due to Immune-Related Adverse Events: A Real-World Data Study

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5550
Author(s):  
Morten Fink ◽  
Anders Schwartz Vittrup ◽  
Lars Bastholt ◽  
Inge Marie Svane ◽  
Marco Donia ◽  
...  
Keyword(s):  
Adverse Events ◽  
Metastatic Melanoma ◽  
Real World ◽  
Negative Impact ◽  
Cox Proportional Hazards Model ◽  
Induction Phase ◽  
Discontinue Treatment ◽  
Real World Data ◽  
World Data ◽  
Significant Difference

Immune-related adverse events (irAEs) are very prevalent when treating patients with ipilimumab and nivolumab in combination, and 30–40% of patients discontinue the treatment for this reason. It is of high clinical relevance to investigate the consequences of discontinuing the treatment early since combination therapy with ipilimumab and nivolumab is the first line of treatment for many patients with metastatic melanoma. In this follow-up study, with real-world data from the nationwide DAMMED database, we investigated whether there was a difference in progression-free survival (PFS) and overall survival (OS) for patients who discontinued or did not discontinue treatment within the first four doses of treatment due to irAEs. In total, 448 patients were treated with ipilimumab and nivolumab. Of these, 133 patients discontinued due to irAEs in the induction phase. Using the Cox proportional hazards model, there was no significant difference in PFS when comparing the group that discontinued with the group that did not discontinue. The group that discontinued had a significantly longer OS than the group that received the full length of treatment. Therefore, we conclude that there is no significant negative impact on efficacy for patients who discontinue due to irAEs in the induction phase of combination immunotherapy for metastatic melanoma.

Predictive Value of First Posttreatment Imaging Using Standardized Reporting in Head and Neck Cancer

2019 ◽  
Vol 161 (6) ◽  
pp. 978-985 ◽  
Author(s):  
Derek Hsu ◽  
Falgun H. Chokshi ◽  
Patricia A. Hudgins ◽  
Suprateek Kundu ◽  
Jonathan J. Beitler ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Head And Neck ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Strong Association ◽  
Treatment Completion ◽  
Tertiary Hospital ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Increased Risk

Objective The Neck Imaging Reporting and Data System (NI-RADS) is a standardized numerical reporting template for surveillance of head and neck squamous cell carcinoma (HNSCC). Our aim was to analyze the accuracy of NI-RADS on the first posttreatment fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (PET/CECT). Study Design Retrospective cohort study. Setting Academic tertiary hospital. Subject and Methods Patients with HNSCC with a 12-week posttreatment PET/CECT interpreted using the NI-RADS template and 9 months of clinical and radiologic follow-up starting from treatment completion between June 2014 and July 2016 were included. Treatment failure was defined as positive tumor confirmed by biopsy or Response Evaluation Criteria in Solid Tumors criteria. Cox proportional hazards models were performed. Results This study comprised 199 patients followed for a median of 15.5 months after treatment completion (25% quartile, 11.8 months; 75% quartile, 20.2 months). The rates of treatment failure increased with each incremental increase in NI-RADS category from 1 to 3 (4.3%, 9.1%, and 42.1%, respectively). A Cox proportional hazards model demonstrated a strong association between NI-RADS categories and treatment failure at both primary and neck sites (hazard ratio [HR], 2.60 and 5.22, respectively; P < .001). In the smaller treatment subgroup analysis, increasing NI-RADS category at the primary site in surgically treated patients and treatment failure did not achieve statistically significant association (HR, 0.88; P = .82). Conclusion Increasing NI-RADS category at the baseline posttreatment PET/CECT is strongly associated with increased risk of treatment failure in patients with HNSCC.

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